Abstract
Although the control of varicella outbreaks is an important health issue, cost could present a major barrier for vaccination. The aim of this study is to investigate the association of vaccine subsidies and caregivers' socioeconomic status with varicella vaccine coverage of their children in Greater Tokyo, Japan, before the period that varicella vaccination was included in routine immunization program. Participants were recruited from two different cities. In Chiba city, parents of 18-month-old infants (N = 378) undergoing a medical examination in July 2013 were recruited at a clinic where no subsidy for varicella immunization was provided. In Nishitokyo city, parents of 24- to 30-month-old children (N = 315) undergoing a health checkup in July and August 2013 were recruited at a clinic where a partial subsidy was provided. The association between household income and varicella immunization was investigated by multivariate logistic regression stratified by city. Vaccine coverage was 61.0% in Chiba city and 73.3% in Nishitokyo city. In Chiba city, odds ratios of middle and high household income for varicella immunization were 4.22 [95% confidence interval (CI): 1.65-10.7] and 5.94 (95% CI: 1.89-18.6), respectively, compared to low household income. However, household income was not associated with varicella vaccination in Nishitokyo city. Neither working status nor education was associated with vaccination in both cities. While household income was associated with high vaccine coverage in the city with no vaccine subsidy, this association was not observed in the city where the subsidy was given, which suggests that cost is a barrier for varicella immunization. Thus, in countries where varicella vaccination is not included in routine immunization programs, introducing subsidies nationwide or routine immunization programs for varicella vaccination would be an important approach to eliminate inequality in vaccine coverage.
Highlights
Varicella is a common, highly infectious disease caused by the varicella-zoster virus that mainly affects young children
Participants were recruited from two cities: 571 parents who attended medical examinations for their 18-month-old infants in Chiba city in July 2013 were recruited at a clinic with no subsidy for varicella immunization, and 342 parents who attended health consultations for their 24- to 30-month-old children in Nishitokyo city in July and September 2013 were recruited at a clinic with a partial subsidy
Subsidies for vaccination should be encouraged in order to remedy health inequality among children in countries where varicella vaccination is not included in routine immunization programs, which has received large attention in previous studies [17, 18]
Summary
Highly infectious disease caused by the varicella-zoster virus that mainly affects young children. Subsidies and Varicella Vaccination of varicella infection. Medical costs associated with varicella infection are a huge burden. The total annual cost associated with varicella is estimated to be JPY 52.2 billion [3]. Antiviral drugs are effective for shortening the duration of the disease [4] and are used in many cases in Japan, even though the patients have no risk of being severe cases, which induces higher cost. The aim of this study is to investigate the association of vaccine subsidies and caregivers’ socioeconomic status with varicella vaccine coverage of their children in Greater Tokyo, Japan, before the period that varicella vaccination was included in routine immunization program
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